Possible clinical implications of peripheral zone changes depending on prostate size

Frost, Joshua; Smith, Lisa A.; Riese, Werner de

doi:10.1007/s11255-019-02221-2

Cited by 9 publications

(14 citation statements)

References 20 publications

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“…The prostate includes three different zones: a central zone, a transitional zone (TZ), and a peripheral zone (PZ). 9 Generally, the interpretation is according to DWI for lesions located at PZ and T2WI for the TZ since csPCa lesions have variable imaging features. 10 Nevertheless, the detection rate of TZ tumors is lower than that of PZ tumors, which needs the assistance of other clinical indexes.…”

Section: Introductionmentioning

confidence: 99%

Development of a nomogram combining multiparametric magnetic resonance imaging and PSA‐related parameters to enhance the detection of clinically significant cancer across different region

et al. 2022

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Objective: Prostate cancer (PCa) is the most prevalent cancer among males. This study attempted to develop a clinically significant prostate cancer (csPCa) risk nomogram including Prostate Imaging-Reporting and Data System (PI-RADS) score and other clinical indexes for initial prostate biopsy in light of the different prostate regions, and internal validation was further conducted. Patients and Methods: A retrospective study was performed including 688 patients who underwent ultrasound-guided transperineal magnetic resonance imaging fusion prostate biopsy from December 2016 to July 2019. We constructed nomograms combining PI-RADS score and clinical variables (prostate-specific antigen [PSA],prostate volume (PV), age, free/total PSA, and PSA density) through univariate and multivariate logistic regression to identify patients eligible for biopsy. The performance of the predictive model was evaluated by bootstrap resampling. The area under the curve (AUC) of the receiver-operating characteristic (ROC) analysis was appointed to quantify the accuracy of the primary nomogram model for csPCa.Calibration curves were used to assess the agreement between the biopsy specimen and the predicted probability of the new nomogram. The χ 2 test was also applied to evaluate the heterogeneity between fusion biopsy and systematic biopsy based on different PI-RADS scores and prostate regions.Results: A total of 320 of 688 included patients were diagnosed with csPCa. csPCa was defined as Gleason score ≥7. The ROC and concordance-index both presented good performance. The nomogram reached an AUC of 0.867 for predicting csPCa at the peripheral zone; meanwhile, AUC for transitional and apex zones were 0.889 and 0.757, respectively. Statistical significance was detected between fusion biopsy and systematic biopsy for PI-RADS score >3 lesions and lesions at the peripheral and transitional zones.

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Section: Introductionmentioning

confidence: 99%

Development of a nomogram combining multiparametric magnetic resonance imaging and PSA‐related parameters to enhance the detection of clinically significant cancer across different region

et al. 2022

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“…Histological (histo)-anatomical studies have also demonstrated that BPH growth within the TZ causes compression-related stress on the PZ. 5 These described histo-anatomical changes are confirmed by a mathematical model demonstrating that “BPH produces the volumetric expansion of the prostate in the perpendicular direction” to the area of the PZ. 8 Besides direct pressure-related tissue injury, reduced blood flow to the PZ may be another permeating factor for glandular atrophy within the PZ.…”

Section: Discussionmentioning

confidence: 79%

“…In these histo-anatomical studies, most of the large prostates with a volume above 80 ml showed a thickened surgical capsule of 10 mm or more. 5 As a significant limitation of these studies, the boundary between the TZ and the PZ cannot be identified, and therefore histo-anatomical specimens are not suitable for measuring zonal thickness within the prostate, and these studies leave the question unanswered whether the PZT stays unchanged, grows, or shrinks in growing BPH prostates.…”

Section: Discussionmentioning

confidence: 99%

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Quantitative measurements of prostatic zones by MRI and their dependence on prostate size: possible clinical implications in prostate cancer

Sellers

Wagstaff

Helo

et al. 2021

Therapeutic Advances in Urology

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Aim: Many studies support an inverse relationship between benign prostate hypertrophy (BPH) size and incidence of prostate cancer (PCa), but the causal link between these conditions is poorly understood. Recent studies suggest that a growing transition zone (TZ) in the prostate may induce pressure on the outer peripheral zone (PZ), leading to atrophy of the glandular tissue where PCa often originates, providing a possible explanation for this interaction. To further investigate this phenomenon, our pilot study uses magnetic resonance imaging (MRI) to examine quantitative zonal changes in a consecutive cohort of prostates. Methods: MRI scans of male patients [ n = 204, 61.57 ± 13.90 years, average body mass index (BMI) 29.05 kg/m2] with various prostate sizes were analyzed statistically to identify possible associations between prostate parameters, such as total prostate volume (TPV) and peripheral zone thickness (PZT). Results: TPV and PZT demonstrated a weak, inverse correlation ( r = −0.21, p = 0.002). However, when examining the plotted data, the relationship between TPV and PZT was significantly different when the cohort was divided into two groups; lower TPV: ⩽87.5 ml ( n = 188, TPV xˉ = 36.01 ± 18.18 ml), and higher TPV: >87.5 ml ( n = 17, TPV xˉ = 125.69 ± 41.13 ml). Average PZT differed significantly between these groups (z = −3.5554, p = 0.0004). Conclusions: PZT was significantly different for patients with lower versus higher TPVs, suggesting that, above a certain point of BPH growth, the PZ is unable to withstand pressure from an expanding TZ, supporting the notion that growing BPH causes compression of the PZ glandular tissue, and, therefore, BPH may be protective against PCa.

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“…While both represent diseases of the prostate, they often occur in distinct anatomic regions, with BPH affecting the central gland (CG), composed of the transition zone and central zone, and Pca occurring in the peripheral zone (PZ) in approximately 70%–80% of cases and 20%–30% in the central gland 1 . The relationship between the two processes has been controversial with some studies indicating higher or no risk of Pca with BPH and others lower risk, with the structural mechanism also uncertain 2–4 …”

Section: Introductionmentioning

confidence: 99%

Benign prostate hyperplasia as a potential protective factor against prostate cancer: Insights from a magnetic resonance imaging study of compositional characteristics

et al. 2021

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Purpose The structural relationship between benign prostate hyperplasia (BPH) and prostate cancer (Pca) is controversial. The purpose of our study was to examine the association between quantitative prostate compositional metrics by magnetic resonance imaging (MRI) and Pca. Methods We identified 405 patients who underwent prostate MRI and biopsy and/or prostatectomy from January 2019 to January 2021 at our institution. Segmentation volumetric methods were used to assess central gland (CG) and peripheral zone (PZ) volume. PZ mean thickness and mean apparent diffusion coefficient (ADC), marker of underlying histologic components, were measured. Multivariable logistic regression was performed with outcomes of ≥Grade Group (GG) 2 Pca and for multifocal disease. Results On multivariable analysis, higher CG volumes were at lower odds of ≥GG2 disease (n = 227) (OR: 0.97, 95% CI 0.96–0.98, p < 0.0001), taking into account PZ volume (p = 0.18) and thickness (p = 0.70). For every one cc increase in CG volume, there was an approximately 3% decrease in odds of ≥GG2 disease. Similar findings were noted for multifocal disease (n = 180) (OR: 0.97, 95% CI 0.96–0.98, p < 0.0001). Notably, ADC of the normal PZ was not significantly associated with CG volume (p = 0.21) nor a predictor of disease (p = 0.49). Conclusions Increasing central gland volume, driven by BPH, is associated with lower odds of significant Pca, including multifocal disease, while PZ anatomic and histologic surrogate changes were noncontributory. Findings support BPH impediment of global tumor growth predicted by theoretical mechanobiological model. This potential stabilizing factor should be further studied for risk stratification and in consideration for BPH therapy.

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Possible clinical implications of peripheral zone changes depending on prostate size

Cited by 9 publications

References 20 publications

Development of a nomogram combining multiparametric magnetic resonance imaging and PSA‐related parameters to enhance the detection of clinically significant cancer across different region

Development of a nomogram combining multiparametric magnetic resonance imaging and PSA‐related parameters to enhance the detection of clinically significant cancer across different region

Quantitative measurements of prostatic zones by MRI and their dependence on prostate size: possible clinical implications in prostate cancer

Benign prostate hyperplasia as a potential protective factor against prostate cancer: Insights from a magnetic resonance imaging study of compositional characteristics

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